Thursday, 31 December 2009

Lessons for those who believe Swine Flu is milder than Common Flu

Swine Flu is not fatal is well treated as shown by Germany, China andJapan.

Only those who treat Swine Flu lightly suffer unnecessary deaths.Without any treatment and ICU, Swine Flu is as deadly as Spanish Fluof 1918. It is only the wide availability of Tamilflu that had reducedfatalities. But those nations that enforce quarantine had fared muchbetter because their ICU facilities are not stretched.

China had done well at the early stages with its aggressive quarantinebut slacked with its quarantine as Swine Flu spreads to its regions.

Among developed nations, Australia suffer the most because its HealthAuthorities treat Swine Flu as milder than Common Flu.

"A World Health Organization report shows Japan's mortality rate is 2deaths for every 100,000 people. The rate is higher by 11 times in theU.K., 16 times in the U.S. and 43 times in Australia

Dec. 11 (Bloomberg) -- Eight hours after Tokyo office worker ShungoYamamoto started feeling feverish and faint, he got a diagnosis ofswine flu, received antiviral drugs and embarked on three days of self-imposed isolation last month.

"I knew it was influenza immediately" because of the fever and jointpain, Yamamoto, 25, said. His doctor confirmed the diagnosis with anose swab test and prescribed five days of Roche Holding AG'santiviral drug Tamiflu. When he left the doctor's office, Yamamoto puton a mask, bought a three-day supply of food, rented DVDs and headedhome, where he stayed for the duration of his illness.

Japan's aggressiveness against H1N1 influenza, the result of hygienestandards, social etiquette and a willingness to test and medicateimmediately, means the country has fared better than the U.S. or theU.K. in battling the first pandemic in 41 years. A World HealthOrganization report shows Japan's mortality rate is 2 deaths for every100,000 people. The rate is higher by 11 times in the U.K., 16 timesin the U.S. and 43 times in Australia.

"No doctor in Japan would tell a flu patient just to go home and sleepit off," said Norio Sugaya, a pediatric specialist at Keiyu Hospitalin Yokohama, a port city south of Tokyo. Sugaya sits on a committeethat advises WHO, a Geneva- based arm of the United Nations, onmanaging swine flu patients.

In the U.K., a study this month found patients typically waited threedays to start taking Tamiflu, one of two medicines available to fightthe new virus as well as seasonal influenza.

Complication Risk

The U.S. Centers for Disease Control and Prevention, based in Atlanta,recommends that antiflu drugs be given to hospitalized patients,pregnant women and others with increased risk of complications. InJapan, doctors are advised to administer the medicines to anyonesuspected of having flu, even if a rapid diagnostic test is negative,according to the Japanese Association for Infectious Diseases, a Tokyo-based organization of specialist doctors that provides treatmentrecommendations.

Japan accounted for three-quarters of the Tamiflu dispensed globallyin the drug's first five years of sale, Roche, based in Basel,Switzerland, said in a November 2005 filing to the U.S. Food and DrugAdministration.

Three years later, Japan's government announced plans to stockpileenough antiflu medicines for 45 percent of its 128 million people.That may be triple the amount required to treat every swine flupatient. The proportion of people sickened by the pandemic virusranges from 7 percent to 15 percent, depending on the country,according to WHO.

Japanese Practices

Japan's status as one of the biggest users of antiviral medicines andits approach to treating seasonal and pandemic flu should be comparedwith practices elsewhere and the data should be published in English,said Lance Jennings, a clinical virologist with Canterbury HealthLaboratories in Christchurch, New Zealand, who has studied flu formore than 30 years.

"If you have better capacity to diagnose cases earlier and aretreating appropriately and early, you're more likely to reduce thenumber of patients who will go on to develop more- severe influenza,"Jennings said in an interview.

While the majority of pandemic flu sufferers got over their illnesswithin days without treatment, 1 percent to 10 percent neededhospitalization and as many as a quarter of those patients requiredintensive care, WHO said on Dec. 4.

Early Treatment

Tamiflu and Relenza, an inhaled medicine made by London- basedGlaxoSmithKline Plc, appear beneficial in fighting the H1N1 virus,especially if treatment begins within 48 hours of the onset ofsymptoms, researchers said in a study in the New England Journal ofMedicine in November. A paper in the same journal in December reportedreduced complications, including deaths, among hospitalized patientstreated with the medications.

A survey of Japanese patients in 2005 found 85 percent sought medicaltreatment for flu and 90 percent of consultations took place within 48hours after the first symptoms appeared, according to David Reddy, whoheads Roche's influenza task force in Basel.

"These people do not wait until it's too late," Reddy said in atelephone interview. "Japan has to be the gold standard of managementof influenza. It's almost a societal response in terms of the waypeople modify their behavior."

Japanese have become accustomed during the past decade to wearingmasks in public to ward off allergic reactions to pollen from cedartrees throughout the country, said Masataka Yoshikawa, a researcherwho tracks consumer behavior at Hakuhodo Institute of Life and Living,the research arm of a Tokyo-based advertising company. Japanese expectsomeone with a cold or flu to wear a mask to limit the spread of thevirus, he said.

Wash and Gargle

"Hand-washing, gargling and wearing masks are three hygiene measuresthat are very well accepted in the community in Japan," said NikkiShindo, the Japanese doctor who is leading WHO's investigation ofswine flu patients. "People don't really hesitate to wear masks inpublic places. Even the 24/7 convenience stores sell high-particulaterespirators at a reasonable price."

Some researchers say they are skeptical that Tamiflu is effective andconcerned that the virus will develop resistance to the drug becauseof misuse. An analysis of 20 studies published in the British MedicalJournal on Dec. 8 showed Tamiflu offered mild benefits for healthyadults and found no proof it prevented lower respiratory tractinfections or complications of flu. There is little evidence to showthat otherwise healthy people should be given Tamiflu routinely, theresearchers said.

'No Doubt'

"Based on our analysis and other subsequent work, there is no doubtthat the drug can reduce complications," said Frederick Hayden, aprofessor of clinical virology at the University of Virginia School ofMedicine in Charlottesville, who was one of the first doctors to studyTamiflu in patients.

Missing doses or failing to complete a course of medicine increasesthe risk that a drug-evading strain will emerge, said William Aldis,an assistant professor of global health at Thammasat University inBangkok and a former WHO representative to Thailand. In societies suchas Japan, where treatment compliance is high, patients are less likelyto contribute to drug resistance, he said.

"So this is one more reason to think carefully before applying Japan'sapproach elsewhere," Aldis said.

Japan, whose flu season typically peaks between January and March, mayface more deaths from H1N1 if the infection trend follows that ofseasonal flu, said Hitoshi Oshitani, a virology professor at TohokuUniversity in Sendai, in northern Japan.

"Japan will enter its regular peak flu season from now, and we have toobserve whether the pattern continues or not," he said. Oshitani, whoadvises WHO on pandemic strategies for developing nations, alsocredits the country's school-closure program for helping battle swineflu.